by Lillian Dell’Aquila Cannon
I have had the pleasure of having my comments on two other blogs deleted, not because of questionable content, but because the authors had no answers for me. Both times, it was because I pointed out that science cannot exist outside of our culture and psychology. What are people so afraid of?
In February, Kirstin, the author of the blog SquintMom, posted two articles on circumcision. According to her site, she provides “resources for evidence-based parenting.” I didn’t see the post back then, but I did recently get a hit to my site from her blog, so I followed the URL. I couldn’t find anywhere on the page where my blog was linked, but I did read the whole article and the comments. As I read, I became more and more angry. In her series about circumcision, she examined the studies on circumcision and concluded that there is no compelling scientific evidence either for circumcision or against it. As you might imagine, she got a lot of dissent from intactivists, much of it well-reasoned. Any time a commenter brought up other studies, or questioned her inclusion or exclusion of any study, she dismissed his or her arguments, at one point going so far as to say “[M]y scientific background provides me with the ability to tease out the fact from the ideology,” as though only she was qualified to assess the evidence, not her interlocutors. As Hugh Young pointed out, appeal to authority does not win an argument. Later, she had to come on to tell the commenters that she actually thinks that circumcision is ethically wrong, but that science does not support that position.
By this point, I was unable to resist and began leaving some pointed comments, questioning her authority and asking for her IQ. At first, she did respond to me on the blog, asking why I wanted to know her IQ, and telling me it was 184. I replied in the comments, but you cannot read my reply on her site because she deleted it. Luckily, I was smart enough to save it in my Gmail, and so can reproduce it here. I wrote:
[I asked for your IQ] to point out that appeal to authority is not a valid argument. Your statement of “I am a scientist so I can understand this” just begged to be taken to the ridiculous end. Maybe I’ll go out and get an IQ test and then whoever wins gets to be right? Or would you agree that that would be a stupid way to decide it?
I would argue that being so involved in science, making your living off of interpreting studies, would make you less objective because you have chosen to focus on science as a way of knowing, which normalizes and privileges that epistemology over all else. My major disagreement is that you seem to be treating the whole topic of routine infant circumcision as an intellectual exercise, which is immoral, because we are talking about real people who are being harmed. I know that the point of your blog is that you think there are objective scientific judgments to be made on parenting hot topics, but that, in itself, is a choice to judge science as a better arbiter of parenting practices than emotions or ethics. You laid out all the science you liked, claimed the other studies were useless, drew a conclusion, then claimed that your conclusion on your chosen science was more valid because you have more authority on the topic. Logical flaws abounded and I could not resist pointing them out.
Science is not a valid way to answer the question of whether babies should be circumcised for non-therapeutic reasons. Apparently you also think it is not ethical, but this only came out after you got attacked for awhile in the comments, and then you wondered why so many people were so angry. As a scientist, you should be aware of all of the times science failed us, and how science cannot exist without ethics, nor can it ever be severed from its cultural underlay.
For example, in the Korean study of circumcised adults, what you need to understand is that in South Korea, men remain intact until their mid-20s or when they are ready to be married. This cultural practice surely informs their subjective evaluation of how circumcision impacted their sexuality, and we cannot ignore the fact that circumcision is a ritual marking the entrance to adulthood and thus has strong emotional and social meanings.
Another commenter pointed out that men who were circumcised for health problems also probably simply felt better because of the cessation of the health problems. This is no small confounding factor, nor is it in American studies showing men who were circumcised as adults felt relief. Men who are adults today grew up ignorant of the foreskin in an anti-foreskin culture – no wonder they felt better when they could relieve themselves of that shameful and embarrassing foreskin. Babies born today are growing up in an evenly split culture that is not ignorant of the foreskin; they will not be ashamed and will value their foreskins.
You also ignore all of the case reports and self-reports of men whose penises were so damaged by circumcision that they cannot function normally, and of the babies who died or lost their glandes or whole penises, because you said the risk is low (as currently reported.) However, there are several cultural and ethical rebuttals to this statement:
-Death and sexual disability from circumcision are not shared socially because parents do not want to share the reason for their baby’s death, likely because it touches on a hidden and unspoken psycho-sexual-cultural practice.
-Deaths from circumcision are usually reported as death from exsanguination or sepsis and thus are hidden from a simple count of death records. It would take a careful epidemiological survey and study of hospital records of all dead male infants to find this, and this would cost money. Who do you think wants to pay for this? Surely not the same industry that earns $500 million a year from circumcision and who has recently made its appeal for continued Medicaid and insurance funding from circumcision.
-Adult men who were damaged by their circumcision also don’t go around trumpeting it because of the shame. You can find them, though, more and more because of intactivism, and you can see some of their pictures and videos on the Global Survey of Circumcision Harm. Perhaps this will produce enough numbers and impressive enough p values for you to take it seriously.
-Finally, and most importantly, it is unethical to perform circumcisions on infants when there is a chance of death and disability (no matter how small) because the proposed benefits of the circumcision can be had without the surgery. It is immoral to risk a baby’s life and sexual functioning to give him benefits that he could have without amputative surgery, while pretending that one’s cultural and religious biases don’t exist. But this is what you get when you do science in a vacuum, and this is why your whole post so incensed me. Science is useful and can answer a lot of questions with great precision and accuracy, but it is not the only epistemology available to us, and not the best, either. It always must be accompanied by ethical concern and a holistic understanding of the phenomenology of the issue being studied. In your haste to squish a very difficult issue into a scientific framework, you have callously disregarded the fact that we are talking about actual human beings who will be affected by the conclusions you or the AAP draws from its chosen science. If, as you say, you see circumcision as ethically wrong, then you have a duty to also say that the science does not answer the question, not because the scientific evidence is equivocal, but because science cannot answer an ethical question like this.
You must also adopt a stance of humility – if there’s one thing that history teaches us, it is that science is always advancing, and what was obvious and true and safe will often become obviously stupid and wrong and unsafe once we know more. You seem extremely intelligent, and I applaud your education and attempts to educate people on the misuse of science, but it would do you credit to say that you don’t know for sure. In the case of routine infant circumcision, we do not know for sure how it will affect any given man, so we do not have the right to impose that decision on him when he cannot resist. This echoes the principle of medical conservatism, which also goes to show how biased many doctors are – if this were any other body part, they wouldn’t say there were benefits in amputating it, but even those intelligent doctors and scientists with IQs of 180+ can be blinded by their own cultural, psychological, and sexual biases.
First, let me point out that I have never deleted any comments on my blog but two: one was a pervert who wrote some really gross stuff (and I have a strong stomach), and one was my sister, who is mentally ill and was trying to upset me. I have let critical comments go through for two reasons: I believe in what I say here, and I am open to changing my mind and considering new opinions. I find it rather pathetic when bloggers delete critical comments – if they wanted their opinions to never be challenged, then perhaps they ought not to have a blog devoted to sharing them. I do not appeal to authority, either. You do not have to listen to me because I have a Ph.D., because I do not, nor because I am a mother of four, because every child and parent is different, nor because my IQ is 184, because I don’t know what it is and am suspicious of IQ tests anyway. My position is always a philosophical position: simply by being in this world we have duties to it and the other living creatures in it. I am not religious, but I know that I have to always try my best to do right by other people, regardless if it makes me uncomfortable. I go out and inadvertently offend people in my family and online about circumcision because I know it is more important to speak for the powerless than it is for me to feel comfortable. I have found that those who defend routine infant circumcision are always defending their own feelings or biases – they are themselves circumcised and don’t want to think about what they are missing, or they have circumcised children and don’t want to think that they might have harmed their children, or they are religious and so will not question the dictates of their religion. I stand by my position on circumcision: it is not the parents’ right to choose to amputate healthy tissue from their child, no matter how pure their motivations. It is fundamentally unjust.
Anyway, back to SquintMom.
I stand by what I wrote on her blog and am reproducing it here because I believe that even though I believe, as does SquintMom, that it is important that science not be misunderstood, I believe it is more important that it not be misapplied beyond its scope. Yes, many people do not have the education to understand even the most rudimentary statistics or science, and this ignorance is bad for public discourse on issues like circumcision. I do think it is valid to try to educate people, but perhaps it would be helpful in this education to include examples of the deliberate misuse of science and math, such as in the case of the African HIV studies that are being used to promote circumcision. David Gisselquist has written extensively on HIV in Africa and the many problems with the three trials used to promote circumcision, and I encourage you to read his analysis. On a more basic level, the authors of that study unethically reported the rate of HIV acquisition between circumcised and intact men as a relative risk, not absolute risk. What do I mean by this? In the 12 months of the study, 1.6% of the circumcised men contracted HIV, while 3.4% of the intact men did. This is the absolute risk (and please note, other African studies saw no difference, or an increase in HIV rates among the circumcised.) The studies’ authors, however, reported it as relative risk: “53% less likely.” They did this because the absolute numbers make circumcision seem pointless to reduce the spread of HIV, and they banked upon the mathematical ignorance (innumeracy?) of the American public to be seriously impressed by the relative rate. This is unethical, and it is a misuse of science which should interest SquintMom.
More important, though, is that the premise of the SquintMom blog is flawed. It is inappropriate and unethical to exclude everything that cannot be assigned a number and lump it all together as “ideology.” Science exists to serve human beings, not some Platonic ideal of a study that has 100% validity that could never exist in the real world. Human beings do studies, and we are inseparable from our cultures and emotions. Pro-circumcision types often claim, as SquintMom did, that there are not studies that prove that circumcised men have less satisfactory sexual experiences. I disagree, as we have the excellent Sorrells study that concluded “The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.” Even so, how exactly would one prove with science that circumcised men and intact men feel the same level of pleasure? Could we record their sexual experiences like in the movie “Strange Days” and then somehow rate who had the most pleasure? Of course not – the experience of pleasure is subjective, and since we have men who are happy being circumcised and men who are unhappy being circumcised, we have no right to impose circumcision on them as it might result in unhappiness.
And that’s the problem with trying to scientifically prove a case for or against circumcision. I do believe that we can and should use science to illuminate the issue, but it cannot be the only way we look at it. Even if routine infant circumcision had huge benefits that could not be had in any other way (which test it currently fails), it still would remove healthy tissue from an unconsenting patient for future benefits in a non-emergent situation, and thus fails even the most basic of medical ethics: beneficence, non-maleficence, justice, autonomy, and proportionality. The biases, emotions, and cultural backgrounds of the human beings doing the science will always be there and can never be severed from the conclusions, though many would like to pretend so.
This problem is not limited to circumcision. As many personality psychologists have pointed out, America has a distinctly positivist, rational bent of thought, valuing science above such “softer, squishier” epistemologies like ethics or emotions. Whether this is because of the effects of detached parenting practices, as my colleague Dr. Darcia Narvaez suggests, or of the culture, or a combination of both, we have seen a lot of it recently, especially in the AAP’s recent statement on circumcision that ignored the ethical questions fundamental to routine infant circumcision, or Pediatrics‘ endorsement of crying it out as a valid nighttime parenting technique. For both of these statements, they chose to privilege scientific studies without addressing the ethics of the questions. I have addressed the ethics of routine infant circumcision repeatedly, but the same argument can be made against leaving a baby to cry it out as a nighttime parenting method: it obviously causes the baby distress (as evidenced by the crying) and is, as we used to say in law school, neither necessary nor sufficient to achieve its goal of sleeping through the night. It is not necessary because babies can learn to sleep longer without being left to cry (our four children all sleep fine without ever crying it out), and it is not sufficient because crying it out doesn’t work once and for all and has to be employed repeatedly as the baby passes through developmental stages (and can eventually get out of bed on his or her own to protest being left alone to cry.) More fundamentally, they didn’t even question the goal of having a baby sleep through the night, which is an American ideal that is not universally shared. Dr. James McKenna of Notre Dame has studied infant sleep and concluded that breastfeeding infants who sleep with their mothers enjoy many benefits. In Japan, children sleep with their parents well into their childhood. The Japanese are unlikely to produce studies that endorse leaving an infant to cry in a room as a valid parenting method because it would never occur to them to have that goal, nor that method to achieve it. Why? The Japanese see children as needing to be integrated into a collectivist society and co-sleep toward that end. Americans see children as needing to be separated from dependents into individuals in an individualistic society, and place them in cribs and try to teach them to “self-soothe.” You see, science is inseparable from culture, and to pretend that there are objective answers to subjective decisions is unethical and cowardly. Routine infant circumcision is a messy issue that evokes strong emotions on both sides, and it should – caring for our babies is of utmost importance. Dismissing that reality as not scientifically verifiable is both a stupid tautology and immoral.
[Postscript: I failed to save the comment I wrote on the other blog that deleted me. This was a valuable lesson to always save my work! I may try to recreate it here for my next post, though.]